Quality of life is ... : the views of older recipients of low-level home support.

AuthorHambleton, Penny


A qualitative study explored the perceptions of quality of life of older people receiving low-level home support in a selected locale in New Zealand. The results shed light on the role that home support at the "lower" end of health resource allocation plays in elderly recipients' quality of life. They also provide insights into these elders' perceptions of current national policy, which advocates both for "ageing in place" and for targeting support to those with higher-level need. Six themes emerge from how these elders talk about and define what quality of life means to them: good people, day-to-day life, keeping healthy, living with loss, at my age, and the future. An in-depth understanding is thus presented of the views of this group of elders in relation to a question of high priority in current economic, health and social debates in New Zealand.


As a concept, quality of life has been subject to considerable academic gaze from many disciplines: philosophy, literature, geography, psychology, health, health economics, advertising and marketing, politics, and the medical and social sciences (Bowling 2001, Hunt 1997, Rapley 2003). Through these diverse lenses, quality of life is viewed from global, national, individual, health-related and social perspectives, contributing to an extensive body of work on quality of life, biased significantly towards quantification (see Bowling 2005, 2001, Hellstrom et al. 2004, Higgs et al. 2003, Hunt 1997, McDowell and Newell 1996, Raphael 1996, Wade 1992). A plethora of measurement methods are used in this literature (Joyce et al. 1999, Rapley 2003, Veenhoven 2005), telling more about quantification than exploring understanding.

Despite all this work, the concept of quality of life has consistently evaded consensus (Albrecht 2006, Clarke 1994, Hunt 1997, Victor et al. 2000). The only apparent agreement is that it is a multi-dimensional construct, although the number and kind of dimensions remain controversial (Haas 1999, Hagerty et al. 2001, Rapley 2003, Smith et al. 2004). Relatively little attention has been paid to understanding quality of life as it is experienced, perceived and interpreted by older people (Farquhar 1995, Gabriel and Bowling 2004, Hendry and McVittie 2004).

Recently, researchers have found that social relations, functional ability and activities may influence the quality of life of older people as much as health status (Wilhelmson et al. 2005). Lawton (1999) has argued that the non-health-related areas of older people's lives may well override the negative aspects of chronic illness and poor health. Quality of life has been identified as a dynamic concept that has the capacity to respond with great fluidity as people's values and priorities change in response to life circumstances and events over the life course (Carr and Higginson 2001).

The silence is overwhelming on the quality of life experience of elders who access home-based support services (Wainwright 2003). This is an interesting predicament here in New Zealand (and elsewhere) considering the prominent place home support (as defined by the Home Support Services National Service Specification 2002) plays as a community service model, in direct response to the international demographic phenomenon of population ageing and the policy directive of ageing in place (Schofield et al. 2006). A recent trial of alternative models of home support driven by a rehabilitative/restorative philosophy has been targeted at high-needs older service users (see ASPIRE 2006). Government funding pressure is already having an impact on this level of home support service, with evidence that the number of people receiving low-level home support is dropping (Chalet al. cited in Wainwright 2003), despite evidence that low-level home support can be effective in preventing entry to institutional care (Cohen cited in Wainwright 2003). All these changes take place without the voice of the largest group of home support users in New Zealand, (1) and in the knowledge that elders' values and how they construct their quality of life remains internationally a neglected area of research (Gabriel and Bowling 2004, Lawton 1999).

This phenomenological study aimed to explore and describe the quality of life of a small group of older people accessing low-level home support in a selected locale in New Zealand. The broad research question to be answered was: How does the provision and delivery of low levels of home support feature in the overall experience of quality of life of older people, including the ability to remain "ageing in place" (Ministry of Social Development 2001) in their community?

Semi-structured interviews explored three broad areas:

* How do older people conceptualise and express quality of life?

* What part does low-level home support play in the experience of quality of life for these older people?

* What is understood by low-level home support and what are the policy development implications?


This study involved nine participants recruited through a local home support provider. The lead researcher is a registered nurse graduate student in gerontology with two academic supervisors. The participants were seven women and two men who lived in their own homes, and from whom data were collected from audio-taped faceto-face interviews. Participants' chronological ages ranged from 79 to 91 years. Ethical approval for the study was granted by the Lower South Regional Ethics Committee.

Thematic analysis was used on the qualitative data (following Crotty 1998), and six themes emerged from how these elders talked about what quality of life means to them. These themes were identified as good people, day-to-day life, keeping healthy, living with loss, the future, and at my age. These themes and their meanings are now discussed, and verbatim quotations from the participants' narratives are used to illuminate key points. Pseudonyms have been used to protect the privacy and confidentiality of elders in this study.


The "good people" in participants' lives--their family, friends, neighbours and home helpers--was the quality of life experience participants talked about most. Having good people around was fundamental to their quality of life experience. "Good people, you couldn't do without them" (Jack).


Family dominated the participants' conversations: spouse, daughters, sons, daughtersin-law, sons-in-law, grandchildren and great-grandchildren. Family members were valued for being there, being with, helping out and feeling included. Family members provide practical, emotional and social support, often reciprocal in nature, translating into a sense of identity, belonging and personal security.

"I always get my hair done on a Friday, and I do my shopping, and my daughter picks me up and we have lunch. Then she brings me home with my groceries and takes me to the hairdresser at one o'clock." (Emma)

"My son lives not too far away and he comes at least once a week and we go up to the supermarket and I just hand him my list. I push the trolley and he does the shopping, I do the paying at the finish [laughter]. He does his shopping at the same time. He works during the week so it works out we can either do it at night or in the weekend. We mainly do it on the Saturday or Sunday when we're not watching football." (Jack)


While less predominant than family, the place of friends was a clear feature in the quality of life experience of eight of the nine participants. As one participant put it, "quality of life depends on one's friends" (Brownie). Similarly to family relationships, the dimensions of close and active ties along with giving and receiving support were evident in these friendships. Friends are discussed here in three different ways: close friends, romantic friends and club friends. Close friends were typically described in terms of informality and easy interactions.

"I've always got friends that ring me up to see how I am and I can ring people any old time. They're sort of all scattered all around. I never know--there might be just a knock at the door and an 'oooh whooo are you at home?' and in they come. They don't ring up and say, 'Well are you going to be at home today?'" (Susie)

Two participants spoke of a "romantic friendship". For Maggie, this has developed since her divorce. "One man lives not far from me. He's a wonderful friend to me. He takes me shopping and he's very good company". Since the death of his wife, Jack reflected, "My wife was a good talker, we talked, we schemed, and we laughed. That's why the lady I see is important. She's like my wife. It makes a terrible difference."

Several participants spoke of their regular social gatherings or interest group meetings.

"There are about 10 to 12 of our ladies meet on the day. We always meet in a local cafe at half past ten on the second Tuesday of the month, and that's another thing that I go to, I never miss, and that's wonderful. We've known each other for a long, long time and it's just lovely." (Emma)

While not a club as such, the three retirement village settings did provide for the maintenance of old friendships and the establishment of new ones.

"Then I have three close friends here, and that's fine, we have a chat every morning on the phone and...

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